Survey of LAN infrastructure and ICT equipment in schools 2005: main report

Nationally representative technical audit of school infrastructure - full repor

Le discours préfaciel : instance de légitimation littéraire

Les stratégies et les procédures de reconnaissance sont multiples dans le champ littéraire et le discours préfaciel représente une institution singulière. À travers un corpus fort représentatif - plus de quatre-vingt-dix préfaces -, l'auteur étudie cette forme de validation de l'oeuvre littéraire. Le processus de légitimation est lié à la légitimité du préfacier. Par ailleurs, l'écrivain établit un pacte avec ce dernier. Même la forme du discours préfaciel est révélatrice. Deux critères de légitimation sont à l'uvre dans le discours préfaciel : le référent situationnel et le référent intertextuel. Le corpus permet d'illustrer les multiples possibilités de ce double référent selon les projets des divers préfaciers, en regard de l'auteur et en regard des lecteurs.Among strategies and procedures of recognition in the domain of literature, prefatory discourse represents a singular institution. Through reference to an extensive corpus of more than 90 prefaces, the author examines this mode of validating literary works. On the one hand, the process of legitimation depends on the legitimacy of the preface writer himself. On the other, the author enters into a pact with him. Even the form of prefatory discourse is revealing. Two criteria of legitimation are at work here: the situational and the intertextual referent. Through its use of the corpus, the article illustrates the multiple possibilities this double referent affords with regard to the author of the work and with regard to its readers, given the preface writers' particular projects

Intravascular Iodinated Contrast Media Administration in Adults: A Patient Safety Approach

In 2013, The ICPS Contrast Media Usage and Exposure Workgroup was formed to review, define, assess and implement best practices regarding the use of intravascular iodinated contrast media (CM) in diagnostic and interventional procedures with respect to the associated risk of contrast media - induced nephropathy (CIN) and other adverse events. The interdisciplinary workgroup consisted of radiologists, cardiologists, nephrologists, nurses, technologists, pharmacists and patient safety experts. The workgroup met regularly to review published best practices and current practices within each member health-system. The workgroup focused on opportunities to improve patient safety within rep resent health-systems and emphasized consensus-based recommendations aimed at reducing intra-institutional variability. Based on current literature, best practices, and professional experience, the workgroup created these recommendations for safe use of intravenous iodinated contrast media. These recommendations do not replace sound clinical judgment or other published guidelines

Use of a retrospective methodology to examine the process of care surrounding serious medical events in HIV-positive patients: a feasibility study

Introduction: Co-morbidities are increasingly common amongst people living with HIV (PLWH) as they age. There is no evidence regarding models of care. We aimed to assess feasibility of a novel methodology to investigate care processes for serious medical events in PLWH. Method: The method was based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Data were extracted from medical records and questionnaires completed by General Practitioners (GPs), HIV physicians, and non-HIV specialist physicians. A panel reviewed anonymised cases and gave feedback on the review process. Results: Eleven out of 13 patients consented to the study. Questionnaires were completed by 64% of HIV physicians, 67% of non-HIV specialist physicians and 55% of GPs. The IRP advised improvement in the methodology including data presentation and timing. Conclusion: This method was acceptable to patients and secondary care physicians. Further work is needed to the improve GP responses and facilitate IRP

Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?

OBJECTIVES: To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. METHODS: Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). RESULTS: GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. CONCLUSIONS: There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them

Reducing risk of overdose with midazolam injection in adults: an evaluation of change in clinical practice to improve patient safety in England

Rationale aims and objectives. This study sought to evaluate potential reductions in risk associated with midazolam injection, a sedating medication, following a United Kingdom National Patient Safety Alert. This alert, ‘Reducing risk of overdose with midazolam injection in adults’, was sent to all National Health Service organisations as a Rapid Response Report detailing actions services should take to minimise risks. Method. To evaluate any potential changes arising from this alert, a number of data sources were explored including reported incidents to a national reporting system for health care error, clinician survey and audit data, pharmaceutical purchasing patterns and feedback from NHS managers. Results. Prior to the Rapid Response Report, 498 incidents were received by the National Patient Safety Agency including 3 deaths. Post implementation of the Rapid Response Report (June 2009), no incidents resulting in death or severe harm had been received. All organisations reported having completed the Rapid Response Report actions. Purchase and use of risk-prone, high-strength sedating midazolam by health care organisations decreased significantly as did the increased use of safer, lower strength doses (as recommended in the Rapid Response Report). Conclusions. Organisations can achieve safer medication practices, better knowledge, awareness and implementation of national safer practice recommendations. Risks from inadvertent overdose of midazolam injection was reduced post implementation of national recommendations. Ongoing monitoring of this particular adverse event will be required with a sustained patient safety message to health services to maintain awareness of the issue and reduction in the number of midazolam related errors

Does resuscitation status affect decision making in a deteriorating patient? Results from a randomised vignette study

Aims and objectives: The aim of this paper is to determine the influence of do not attempt cardiopulmonary resuscitation (DNACPR) orders and the Universal Form of Treatment Options (‘UFTO’: an alternative approach that contextualizes the resuscitation decision within an overall treatment plan) on nurses' decision making about a deteriorating patient. Methods: An online survey with a developing case scenario across three timeframes was used on 231 nurses from 10 National Health Service Trusts. Nurses were randomised into three groups: DNACPR, the UFTO and no-form. Statements were pooled into four subcategories: Increasing Monitoring, Escalating Concern, Initiating Treatments and Comfort Measures. Results: Reported decisions were different across the three groups. Nurses in the DNACPR group agreed or strongly agreed to initiate fewer intense nursing interventions than the UFTO and no-form groups (P < 0.001) overall and across subcategories of Increase Monitoring, Escalate Concern and Initiate Treatments (all P < 0.001). There was no difference between the UFTO and no-form groups overall (P = 0.795) or in the subcategories. No difference in Comfort Measures were observed (P = 0.201) between the three groups. Conclusion: The presence of a DNACPR order appears to influence nurse decision making in a deteriorating patient vignette. Differences were not observed in the UFTO and no-form group. The UFTO may improve the way nurses modulate their behaviours towards critically ill patients with DNACPR status. More hospitals should consider adopting an approach where the resuscitation decisions are contextualised within overall goals of care

Chimeric hepatitis B virus/hepatitis C virus envelope proteins elicit broadly neutralizing antibodies and constitute a potential bivalent prophylactic vaccine.

International audienceThe development of a prophylactic vaccine against hepatitis C virus (HCV) has become an important medical priority, because 3-4 million new HCV infections are thought to occur each year worldwide. Hepatitis B virus (HBV) is another major human pathogen, but infections with this virus can be prevented with a safe, efficient vaccine, based on the remarkable ability of the envelope protein (S) of this virus to self-assemble into highly immunogenic subviral particles. Chimeric HBV-HCV envelope proteins in which the N-terminal transmembrane domain of S was replaced with the transmembrane domain of the HCV envelope proteins (E1 or E2) were efficiently coassembled with the wild-type HBV S protein into subviral particles. These chimeric particles presented the full-length E1 and E2 proteins from a genotype 1a virus in an appropriate conformation for formation of the E1-E2 heterodimer. Produced in stably transduced Chinese hamster ovary cells and used to immunize New Zealand rabbits, these particles induced a strong specific antibody (Ab) response against the HCV and HBV envelope proteins in immunized animals. Sera containing anti-E1 or anti-E2 Abs elicited by these particles neutralized infections with HCV pseudoparticles and cell-cultured viruses derived from different heterologous 1a, 1b, 2a, and 3 strains. Moreover, the anti-hepatitis B surface response induced by these chimeric particles was equivalent to the response induced by a commercial HBV vaccine. Conclusions: Our results provide support for approaches based on the development of bivalent HBV-HCV prophylactic vaccine candidates potentially able to prevent initial infection with either of these two hepatotropic viruses. (HEPATOLOGY 2013)